Transmittal and Notice of Approval of State Plan Material and Supporting Regulations in 42 CFR 430.10-430.20 and 440.167

Transmittal and Notice of Approval of State Plan Material and Supporting Regulations in 42 CFR 430.10-430.20 and 440.167 (CMS-179)

OMB: 0938-0193

IC ID: 7877

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Transmittal and Notice of Approval of State Plan Material and Supporting Regulations in 42 CFR 430.10-430.20 and 440.167
 
Yes Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 430.10 42 CFR 430.20 42 CFR 440.167

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-179 Transmittal Notice of Approval of State Plan Material cms179.pdf Yes No Fillable Printable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,681 0 0 4,625 0 56
Annual IC Time Burden (Hours) 9,271 0 0 8,711 0 560
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
DCIS att 4 39A DCIS att 4 39A .doc 01/09/2009
DCIS att 4 39B DCIS att 4 39B .doc 01/09/2009
DCIS sec 4 39 PASRR DCIS sec 4 39 PASRR.doc 01/09/2009
DEH rev4 17 Liens Adj Rec p53 No Att DEH rev4 17 Liens Adj Rec p53 No Att.doc 01/09/2009
DEH rev4 22 Base Plan TPL p69,69a,70 DEH rev4 22 Base Plan TPL p69,69a,70.doc 01/09/2009
DEH rev 2 PRA Base Plan Territory-Section2 DEH rev 2 PRA Base Plan Territory-Section2.doc 01/09/2009
DEH rev PRA Base Plan PRA State-Section2 DEH rev PRA Base Plan PRA State-Section2.doc 01/09/2009
DEH Section 3 pages PRA version 7 10 08 DEH Section 3 pages PRA version 7 10 08.pdf 01/09/2009
DEH_State 2 6-A PRA (2) DEH_State 2 6-A PRA (2).pdf 01/09/2009
DEH_State 2 DEH_State 2.2-A PRA.doc 01/09/2009
DEH_State-Section2 Base DEH_State-Section2 Base.doc 01/09/2009
DEH_Territory-2 2-A PRA508 DEH_Territory-2 2-A PRA508 .pdf 01/09/2009
DEH_Territory-2 6-A PRA (2) DEH_Territory-2 6-A PRA (2).pdf 01/09/2009
DEH_Territory-Section2 Base DEH_Territory-Section2 Base.doc 01/09/2009
Exhibits for Base Plan PRA Pages Exhibits for Base Plan PRA Pages.doc 01/09/2009
FCH rev 431_434 FCH rev 431_434.doc 01/09/2009
FMG rev4 19 b - DP Revision 07-17-08 FMG rev4 19 b - DP Revision 07-17-08.doc 01/09/2009
FMG4 19b preprint 7-29-08 FMG4 19b preprint 7-29-08.pdf 01/09/2009
FMG rev4 19 (k) page 66a FMG rev4 19 (k) page 66a.doc 01/09/2009
FMG rev4 19 Att 4 19-B sec 24p1a FMG rev4 19 Att 4 19-B sec 24p1a.DOC 01/09/2009
FMG rev4 19 B supp1 preprint FMG rev4 19 B supp1 preprint.doc 01/09/2009
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